Do you have back pain potentially caused by AS (Ankylosing Spondylitis)?*

Yes

No

Has your back pain lasted longer than 3 months?*

Yes

No

Is your back pain the result of a recent injury (<6 mos)?*

Yes

No

Have you been diagnosed with rheumatoid arthritis (RA)?*

Yes

No

Would you be interested in home delivery of your RA medications?*

Yes

No

Are you currently taking a DMARD medication to treat your RA?*

Yes

No

Have you or someone in your household seen a rheumatologist in the past 12 months?*

Yes

No

Do you experience arthritis pain in your hands?*

Yes

No

What type of diabetes do you have?*

Type 1

Type 2

Which method(s) best describe how you manage your diabetes?*

Oral

Insulin

Other

Were you diagnosed with diabetes within the last year?*

Yes

No

How many oral medications do you use to treat your diabetes?*

1

2 or more

None

Do you have uncontrolled A1C levels (7 or above)?*

Yes

No

Do you currently use an anti-coagulation therapy, such as Coumadin or Warfarin?*

Yes

No

Would you be interested in home delivery of your IBD (Crohn's/UC) medications?*

Yes

No

Have you been diagnosed with moderate-to-severe Crohn’s Disease?*

Yes

No

Do you experience 2 or more flares (symptoms lasting more than 24 hours) a year from your Crohn’s Disease?*

Yes

No

Are you currently being treated with a prescription medication for your Crohn’s Disease?*

Yes

No

Have you been diagnosed with moderate-to-severe Ulcerative Colitis?*

Yes

No

Do you experience 2 or more flares (symptoms lasting more than 24 hours) a year from your Ulcerative Colitis?*

Yes

No

Are you currently being treated with a prescription medication for your Ulcerative Colitis?*

Yes

No

Have you or someone you care for been diagnosed with moderate to severe acne?*

Yes

No

Have you had any minor or major surgeries over the last year?*

Yes

No

Have you or a loved one been diagnosed with cancer?*

Yes

No

Do you or a loved one suffer from Psoriasis?*

Yes

No

Do you or a loved one struggle with ADD or ADHD?*

Yes

No

Do you suffer from eczema?*

Yes

No

If you are using medications to treat your depression, would you be interested in home delivery of your medications?*

Yes

No

Are you currently taking anticoagulant medications?*

Yes

No

Would you be interested in home delivery of your anticoagulant medications?*

Yes

No

Are you treating or being treated for toenail fungus?*

Yes

No

Have you been diagnosed with hepatitis C?*

Yes

No

Is your child at least 1 month old but less than 3 years old?*

Yes

No

Are you 18 years of age or older?*

Yes

No

Is the person you’re caring for 10 years of age or older?*

Yes

No

Have you or a loved one been diagnosed or are suffering with Neuropathy?*

Yes

No

Have you or a loved one been diagnosed or are suffering with Fibromyalgia?*

Yes

No

Has a doctor or specialist diagnosed you with Sleep Apnea?*

Yes

No

Are you 40 years old or older?*

Yes

No

Are you or a loved one concerned about having a fall or accident at or away from home?*

Yes

No

Would you like to learn more about assisted living options for you or a loved one?*

Yes

No

Are you limited in your ability to work? You may be eligible for Social Security Disability Insurance Benefits of up to $2,533 per month. Click yes to get a free evaluation and find out if you may qualify.*

Yes

No

Are you interested in enrolling in a Medicare Supplemental Insurance plan that can help you pay for some of the costs that Medicare does not cover? (Must be 65 or older to qualify)*